1
|
Horisawa S, Kawamata T, Taira T. Seven-year resolution of cervical dystonia after unilateral pallidotomy: A case report. Surg Neurol Int 2022; 13:586. [PMID: 36600748 PMCID: PMC9805625 DOI: 10.25259/sni_840_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background Reports on the long-term effects of pallidotomy for cervical dystonia remain scarce. Case Description We report a case of cervical dystonia successfully treated by unilateral pallidotomy. The patient was a 29-year-old man without past medical and family history of cervical dystonia. At the age of 28 years, neck rotation to the right with right shoulder elevation developed and gradually became worse. After symptoms failed to respond to repetitive botulinum toxin injections and oral medications, he underwent left pallidotomy, which resulted in significant improvement of cervical dystonia and shoulder elevation without surgical complications. At the 3-month evaluation, the symptoms completely improved. The Toronto Western Spasmodic Torticollis Rating Scale score dramatically improved from 39 points before surgery to 0 points at 7-year postoperative evaluation. Conclusion This case suggests that unilateral pallidotomy can be an alternative treatment option for cervical dystonia.
Collapse
Affiliation(s)
- Shiro Horisawa
- Corresponding author: Shiro Horisawa, Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan.
| | | | | |
Collapse
|
2
|
Lin S, Wang L, Shu Y, Guo S, Wang T, Li H, Zhang C, Sun B, Li D, Wu Y. Rescue procedure for isolated dystonia after the secondary failure of globus pallidus internus deep brain stimulation. Front Neurosci 2022; 16:924617. [PMID: 36061614 PMCID: PMC9434021 DOI: 10.3389/fnins.2022.924617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionGlobus pallidus internus (GPi) deep brain stimulation (DBS) is widely used in patients with dystonia. However, 10–20% of patients receive insufficient benefits. The objectives of this study are to evaluate the effectiveness of bilateral subthalamic nucleus (STN) DBS along with unilateral posteroventral pallidotomy (PVP) in patients with dystonia who experienced unsatisfactory GPi-DBS and to address the reported rescue procedures after suboptimal DBS or lesion surgery in dystonia patients.MethodsSix patients with isolated dystonia who had previously undergone bilateral GPi-DBS with suboptimal improvement were included. Standardized assessments of dystonia using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and quality of life using SF-36 were evaluated before surgery and 1, 6 months, and last follow-up (LFU) after surgery. STN bilateral OFF (bi-OFF), unilateral ON (uni-ON), and bilateral ON (bi-ON) states were recorded at LFU. Specific items were used to find publications published before 10 April 2022 regarding rescue procedures after suboptimal DBS or lesion surgery in patients with dystonia for reference. Eleven original studies including case reports/series were identified for discussion.ResultsSubstantial clinical benefits were achieved in all six patients. Significant amelioration was achieved during the 1-month (6.5 ± 7.45; p = 0.0049), 6-month (5.67 ± 6.3; p = 0.0056) follow-ups, and at LFU (4.67 ± 4.72; p = 0.0094) when compared with the baseline (LFU of GPi DBS with on status) (17.33 ± 11.79) assessed by BFMDRS. The percentage of improvement reached 70.6, 74.67, and 77.05%, respectively. At LFU, significant differences were found between the stimulation bi-OFF and uni-ON (11.08 ± 8.38 vs. 9 ± 8.52, p = 0.0191), and between the stimulation bi-OFF and bi-ON (11.08 ± 8.38 vs. 4.67 ± 4.72, p = 0.0164). Trends depicting a better improvement in stimulation bi-ON compared with uni-ON (4.67 ± 4.72 vs. 9 ± 8.52, p = 0.0538) were observed.ConclusionOur results suggest that bilateral STN-DBS plus unilateral PVP may be an effective rescue procedure for patients with isolated dystonia who experienced suboptimal movement improvement following GPi-DBS. However, given the heterogeneity of patients and the small sample size, these findings should be interpreted with caution.
Collapse
Affiliation(s)
- Suzhen Lin
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingbing Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimei Shu
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shunyu Guo
- Department of Neuro-Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxia Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Dianyou Li,
| | - Yiwen Wu
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yiwen Wu,
| |
Collapse
|
3
|
Jetjumnong C, Norasetthada T. Modified McKenzie-Dandy operation for a cervical dystonia patient who failed selective peripheral denervation: A case report and literature review. Surg Neurol Int 2022; 13:31. [PMID: 35242397 PMCID: PMC8888194 DOI: 10.25259/sni_844_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Cervical dystonia (CD) is a rare and difficult-to-treat disorder. Various neurosurgical options are available, each with its own set of advantages and disadvantages. We investigated using the modified McKenzie-Dandy operation for a patient with CD who failed selective peripheral denervation (SPD).
Case Description:
A 42-year-old man presented left-sided rotational torticollis for 3 years. He was referred for surgery after treating with a variety of oral medications and repeated botulinum toxin injections that became ineffective. For the first operation, the patient underwent SPD (modified Bertrand’s operation); unfortunately, the postoperative outcome was unsatisfactory, and the operation was considered a failure. After his symptoms did not improve after 6 months, the modified McKenzie-Dandy operation was performed. Immediately following surgery, he experienced satisfactory outcomes. He was able to resume his normal activities and employment after 1 month after recovering from his temporary swallowing difficulties. He only complained of minor neck pain and no recurrence was observed after 3 years follow-up.
Conclusion:
For patients who have failed SPD, a modified McKenzie-Dandy procedure is a feasible and effective option. The procedure is relatively safe when performed properly, and the long-term effects can be maintained.
Collapse
|